Job Description & How to Apply Below
We are seeking an experienced Billing Manager to oversee the full revenue cycle for a behavioral healthcare facility operating primarily on an out-of-network basis. This role is responsible for facility-level payer enrollment and readiness, intake financial clearance, utilization review coordination, claims submission, denials management, appeals, reimbursement negotiations, and collections.
The successful candidate will understand how commercial payers process facility claims in OON behavioral health settings and can build disciplined, compliant workflows across intake, clinical, and billing functions.
Role Scope & Responsibilities:
1. Facility Payer Enrollment & OON Readiness
• Manage facility-level payer enrollments and registrations required for out-of-network billing.
• Maintain payer profiles, taxonomies, NPIs, W-9s, licenses, accreditation records, and ownership disclosures.
• Track payer notification requirements for new locations, program launches, or service line expansions.
• Support single-case agreements and ad-hoc reimbursement discussions when needed.
2. Intake Financial Clearance & Verification of Benefits
• Direct VOB workflows prior to admission.
• Ensure accurate interpretation of OON benefits, deductibles, and patient responsibility.
• Confirm authorization or notification requirements.
• Align admissions and billing teams on coverage expectations.
3. Utilization Review & Clinical Coordination
• Oversee timely initial and concurrent UR submissions.
• Coordinate continued-stay requests with clinical leadership.
• Manage medical record production for audits, post-service requests, and disputes.
• Maintain documentation standards tied to reimbursement defensibility.
4. Claims Submission & Coding Oversight
• Ensure accurate, timely facility claim submission.
• Monitor clearinghouse rejections and front-end edits.
• Validate charge capture and revenue integrity.
• Confirm proper revenue codes, CPT/HCPCS, ICD-10, and modifiers.
5. Denials Management & Underpayment Recovery
• Lead root-cause analysis for denials.
• Direct appeal strategies and escalation paths.
• Coordinate peer-to-peer and medical director reviews.
• Pursue underpayment disputes and reconsiderations.
6. Appeals, Disputes & Payer Negotiations
• Develop payer-specific appeal templates and escalation pathways.
• Manage external review processes where applicable.
• Lead high-dollar claim escalations.
• Track overturn rates and reimbursement outcomes.
7. Accounts Receivable & Final Collections
• Oversee payer follow-up cadence and aged AR.
• Manage write-off thresholds and settlement strategies.
• Ensure secondary and patient balance resolution.
8. Reporting, Forecasting & Performance
• Produce dashboards covering:
o Days in AR
o OON reimbursement yield
o Denial categories
o Appeal success rates
o Cash collections
• Identify revenue risk and improvement opportunities.
9. Team Leadership & SOP Development
• Manage billing, UR, and AR staff.
• Build SOPs and QA programs.
• Support hiring and scaling.
Qualifications:
Required
• 5+ years in behavioral healthcare revenue cycle management.
• Demonstrated experience with facility-based OON billing.
• Working knowledge of VOB, UR, claims, denials, appeals, and collections.
• Understanding of commercial payer OON processing rules.
• Strong operational leadership.
Preferred
• Residential, PHP, or IOP program experience.
• Multi-state facility operations.
• Experience with major RCM platforms and clearinghouses.
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